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FEATURE

SMS SOS

Young people are increasingly turning to their phones to find support in the midst of a crisis.
Illustration by Anna Godeassi

Two and a half years later, it’s the loneliness of the kids that still gets to Lisa Qvistgaard. 

It was loneliness, particularly within teenagers, that first led Qvistgaard to become a volunteer crisis counselor with the Crisis Text Line. Witnessing the challenges her own teenage daughter was going through, she imagined the lives of kids with similar mental health struggles who didn’t have the means to pay a therapist and started searching for a way to make it better. That’s when she saw a news story about Crisis Text Line.

Now, four times per week, for an hour at a time, Qvistgaard logs on from her Davis, California, home and takes text messages from people—mostly young people—who are in crisis. The subject matter of the texts spans the gamut, from expressions of school or workplace anxiety to suicidal thoughts to reports of rape or sexual assault. 

The people on the other end often have nowhere else to turn, so they punch 741-741 into their phones and send a text message to the anonymous, faceless counselors of Crisis Text Line.

“It breaks my heart just how alone so many of these kids are,” Qvistgaard says. “Either they have no one to talk to about this or they’re afraid to burden their parents with their problems. There are so many of them.”

The ranks are growing rapidly. 

In 2015, Crisis Text Line had about 600 counselors fielding messages from around the country. By the end of 2017, that number had ballooned to nearly 4,000 counselors. In its first four years, it exchanged more than 62 million messages. The Crisis Text Line leadership expects that number to double in 2018. Of its interactions, Crisis Text Line co-founder Nancy Lublin says that more than 75 percent were initiated by people under the age of 25; more than 10 percent were under the age of 13.

“There have been a handful of eye-opening things that we’ve learned,” Lublin explains. “The growth was not something I really expected.”

Lublin and co-founder Stephanie Shih started Crisis Text Line while working together on another national nonprofit, DoSomething.org, which helps young people organize volunteer campaigns. Shih received a text message one night in 2011 from a teenage volunteer who said she was the victim of an ongoing sexual assault.

Unsure of what to do, Shih began a dialogue. She determined that the girl was not in immediate danger, encouraged her to reach out to a national rape hotline and, ultimately, helped her get connected. 

The experience sparked an idea for Shih and Lublin: a text-based option for reporting mental health issues. A little more than two years later, Crisis Text Line was up and running. 

“Texting feels familiar to us, and it’s less personal,” Lublin says, explaining why she thinks the service has been so popular. “You never have to see a face. There’s no judgment. You have an opportunity to put your words together and say exactly what you want to say in a way that you can’t always do verbally. And now, it’s simply a way that we all communicate.”

 

Someone to Listen 

The people on the receiving end of these millions of texts are trained crisis counselors who volunteer, like Qvistgaard, to answer the desperate messages that pour into Crisis Text Line. The counselors, who usually answer messages from their homes, are not licensed. Most of them have no background in mental health, but none of that is required to do the job.

“Our objective during an interaction is to take a person from hot to cool calm,” says Dr. Shairi Turner, a Harvard-trained doctor and Crisis Text Line’s chief medical officer. “We’re very clear about our role. We are not long-term care. We have a bank of referrals to send people so they can receive help on a steady basis. Our goal is to work through a crisis.”

That is not to say that volunteers are untrained. Qvistgaard found the 36-hour training course to be thorough, and she says it prepared her for most of the interactions she’s faced. The training includes dozens of examples from past exchanges between texters and counselors and tips for improving upon those exchanges. Each counselor-in-training is also expected to monitor a number of live exchanges. Crisis Text Line performs a background check on counselors, and all applicants undergo a personality test to gauge their compatibility with the job.

And counselors are never working alone. According to Qvistgaard, a supervisor monitors all conversations and can be alerted if there is trouble or if a counselor simply gets stuck in a conversation. Counselors can also seek help through an online forum and, while they can’t see the phone number or the location the message comes from (messages filter through an anonymizing platform), supervisors can access the information if a crisis escalates.

“If there is ever an emergency situation, we would dispatch the police,” Turner says. “This again goes back to understanding our role. Our entire focus is moving out of that crisis situation, allowing the person to talk through it. Most often, that’s all anyone wants—someone to listen.”

 

Serving the Underserved

In the United States today, people who are trained to listen are in short supply. The Bureau of Labor Statistics in 2010 found that nearly 90 million Americans lived in an area with a shortage of mental health services. In addition, mental health care is often very expensive, some treatments are not covered by traditional insurance and there is a stigma that often deters people from seeking help.

This scarcity is particularly felt by young people who live in rural areas, where many health care options are limited, especially mental health services.

“We tend to skew young and rural among our most frequent users,” Lublin says. “If you research the areas, it’s not hard to understand why. Rural teens experience the same mental health issues and the same trauma; they just have no outlet for treatment.”

Access to care is a problem for minors across the United States. In 2017, a survey of young people with major depression conducted by Mental Health America found that only 23.4% of them received consistent treatment (7 or more visits a year with a mental health professional). And 63% received no mental health treatment at all. Even teens covered by insurance aren't guaranteed treatment—and they're certainly not guaranteed adequate treatment. 

“If I didn’t have the means, I’m not sure what I would do for my daughter, but I know that it is incredibly expensive,” Qvistgaard says. “When I think about the kids, and their parents, who don’t have the means, it breaks my heart to consider that hopeless feeling, because there is nowhere to turn.”

Our entire focus is moving out of that crisis situation, allowing the person to talk through it. Most often, that’s all anyone wants—someone to listen.

A Tool for Schools

It often lands in the laps of teachers and administrators to serve as a first line of defense when it comes to spotting minors in a crisis situation—from catching early signs of bullying, to noticing that top students are suddenly slacking off, to witnessing emotional outbursts. 

“I tell teachers that when a student is acting out, they should take a step back and consider what’s going on, what’s the bigger picture,” Turner says. “That child has typically endured some level of trauma and is struggling to deal with it.”

The problem, of course, is what concerned teachers and school administrators should do when they suspect a student is struggling with anxiety or depression or is the victim of bullying. It’s clearer in situations in which there is an apparent danger; educators have a duty to report that to the local authorities. But more and more schools and districts are relying on Crisis Text Line as a way to help students who fall into the gray area. A number of schools have placed the 741-741 number on the back of student ID cards, and they’ve pushed the effort through local media outlets.

Bring the Crisis Text Line into your Classroom

Downloading and displaying this poster from Crisis Text Line can ensure that students in your classroom know this resource exists—and know how to reach out.

“Teachers know that this is a problem, and they know that some kids need help,” says Qvistgaard, who was responsible for getting Davis-area schools to place the Crisis Text Line number on their ID cards. “Parents ask me for the number all the time, too, because they’re also concerned about their kids. A lot of the kids don’t want to talk to adults that they know, especially their parents. Either they’re embarrassed or they’re afraid they’re burdening them.”

So Crisis Text Line fills the gap, providing a convenient, anonymous option for young people. But sometimes it becomes a bit too easy and, instead of a serving as a short-term solution, Crisis Text Line becomes a substitute for the long-term help that a client truly needs.

“We do have to cut people off,” says Turner, who notes there’s a detailed protocol for how to respond to users who overuse the line and connect them to the care they need. “That’s obviously a tough situation, but we can’t allow it, because it’s not helping anyone. That’s not what we’re here to do and we know it.”

And the counselors at Crisis Text Line know it, too. 

“Crisis Text Line offers an alternative—an anonymous, non-judgmental stranger to just listen and be on their side,” Qvistgaard says. “Just let them calm down a little. That’s what we do.”

Moon is an award-winning columnist and investigative reporter working in Montgomery.

Texting Trends

The success of Crisis Text Line has been somewhat bittersweet for co-founder Nancy Lublin. 

 

After all, the rapid growth indicates huge numbers of troubled Americans searching for someone to hear them out. That’s a sad reality that Lublin admits has caught her by surprise. 

 

But on the other hand, Crisis Text Line’s makeup—with thousands of volunteer counselors taking in messages from all over the country—presents Lublin, a self-professed data lover, with an opportunity to provide hard facts for a complicated issue that is usually discussed in broad, general terms.

 

“One of the roles that we see for ourselves here is a real-time data center,” Lublin says. “We have the means because of our unique positioning to gather data that has never before been compiled.”

 

Lublin is not talking about personal data, and she stresses that Crisis Text Line is completely anonymous and will remain so. But all of the non-identifiable information about a message sender is gathered and entered into the database—everything from the area code where the message originated and reason for contact to basic demographic data like age, gender and race. 

 

The database has allowed Crisis Text Line, which has several interactive maps on its webpage displaying the gathered data, to collect some unique information—information that can allow policymakers to make informed decisions. Currently, Crisis Text Line partners with organizations, such as the National Eating Disorder Association, and government entities to share real-time, evolving data sets that help stakeholders and policymakers better understand the crises they’re working against. 

 

The continually changing data have allowed Crisis Text Line to spot trends that might otherwise go unnoticed. Lublin told The New York Times last year that the release of the Netflix show 13 Reasons Why corresponded with an increase in large groups of teens reporting suicidal thoughts, with 5 percent of users mentioning the show. That sort of information could be vital to school systems and suicide prevention efforts. 

 

It could also be vital to expanding mental health care resources for low- and middle-income Americans. Some states have already started studying Crisis Text Line’s data, looking for trends and attempting to better understand the problems and how to direct limited resources to the right places.

 

“We do not see our role here as that of pushing for specific policies. Instead, we believe we can provide good data to those who are in those roles,” Lublin says. “Our goal is a system of mental health care that is based on actual facts.”

 

Some of those facts have been surprising to Lublin. For example, when she started the service, Lublin believed that the majority of messages from younger people would be related in some way to bullying. That hasn’t been the case. In fact, only around 3 percent of messages are bullying-related. By far the highest numbers are messages related to anxiety—a fact that continues to astound Lublin and her team. 

 

“That kids today have so much anxiety is really something I didn’t see coming, because we just don’t tend to think of kids having adult-level stress like that,” Lublin says. 

 

The other figure that gives Lublin pause: the age of some message senders. This year, Crisis Text Line is expected to exchange more than 50 million messages with people in crisis. More than 10 percent of those messages will be sent by kids 13 years old or younger. And of that group of 13-year-olds, more than 20 percent admit to self-harming. 

 

“I just can’t wrap my head around that, because so many 13-year-olds don’t even have a phone,” Lublin says. “And the prevalence of self-harming was a huge surprise. It’s something you never hear talked about.” 

 

Those numbers are not terribly surprising, though, to one Crisis Text Line executive. Dr. Shairi Turner has spent her professional life working with children who have experienced trauma. 

 

“Unfortunately, the young age is not a surprise, because so many children are being born into homes where mental health issues that have gone untreated are a fact of life,” Turner says. 

 

“These facts say a lot about the state of our mental health services in this country, as does the growth of Crisis Text Line. The demand for these services is there, clearly.”